Preoperative laboratory testing for total hip arthroplasty: Unnecessary tests or a helpful prognosticator.
In: Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, Jg. 25 (2020-09-01), Heft 5, S. 854-860
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Zugriff:
Background: The last decade has seen increasing initiatives to improve health care delivery while decreasing financial expenditures, as particularly exemplified by the implementation of bundled payments for lower extremity arthroplasty, which hold the providers responsible for the both the quality and cost of these procedures. In this context, the utility of routine preoperative laboratory testing is unknown. The present study characterizes the associations, if any, between preoperative sodium, blood urea nitrogen (BUN), and creatinine values and the occurrence of general health adverse outcomes following total hip arthroplasty (THA).
Methods: Patients undergoing primary THA were identified in the 2011-2015 National Surgical Quality Improvement Program. Cases with traumatic, oncologic, or infectious indications were excluded. Preoperative levels of sodium, BUN, and creatinine were tested for associations with perioperative adverse events and adverse hospital metrics using multivariate regressions that adjusted for patient baseline characteristics.
Results: A total of 92,093 patients were included, of which 5.25% had an abnormal preoperative sodium level, 24.20% had an abnormal preoperative BUN level, and 11.95% had an abnormal preoperative creatinine level. Abnormal preoperative sodium levels (odds ratios: 1.23-1.50, p < 0.007) and creatinine levels (odds ratios: 1.27-1.55, p < 0.007) were associated with the occurrence of all studied adverse outcomes and abnormal preoperative BUN levels (odds ratios: 1.15-1.52, p < 0.007) were associated with the occurrence of all adverse outcomes except for hospital readmission.
Conclusions: Abnormal preoperative laboratory testing is significantly associated with adverse outcomes following THA, supporting the added value of laboratory evaluation of patients before elective arthroplasty procedures.
Study Design: Clinical, Level III.
Competing Interests: Declaration of Competing Interest The authors have no ownership, patents, or participations with entities whose products or category of products are mentioned in the current manuscript. No funding was received for this study. The authors of the manuscript do declare the following financial conflicts unrelated to the current manuscript: One of the authors (JNG) reports the following financial activities outside the submitted work: past consultancy with Medtronic (Minneapolis, MN, USA), Bioventus (Durham, NC, USA), Stryker (Mahwah, NJ, USA), and TIDI products (Neenah, Wisconsin, USA); and participation in a clinical trial as a sub-investigator for Pfizer (New York City, NY, USA), Spinal Kinetics (Sunnyvale, CA, USA), and Orthofix (Lewisville, TA, USA). All other authors certify that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article.
(Copyright © 2019 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)
Titel: |
Preoperative laboratory testing for total hip arthroplasty: Unnecessary tests or a helpful prognosticator.
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Autor/in / Beteiligte Person: | Ondeck, NT ; Fu, MC ; McLynn, RP ; Bovonratwet, P ; Malpani, R ; Grauer, JN |
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Zeitschrift: | Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, Jg. 25 (2020-09-01), Heft 5, S. 854-860 |
Veröffentlichung: | 2016- : Tokyo : Elsevier ; <i>Original Publication</i>: Tokyo : Springer-Verlag Tokyo, c1996-, 2020 |
Medientyp: | academicJournal |
ISSN: | 1436-2023 (electronic) |
DOI: | 10.1016/j.jos.2019.09.019 |
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